Nigerians are experiencing neuro-long COVID

• Patients previously hospitalized with COVID-19 reported neuro-long COVID symptoms more frequently than those who had a mild form of COVID-19 and did not require hospitalization (11.5% vs 3.9%)
• Among those with long COVID, 59.4% had memory problems/brain fog and 55.7% had fatigue
• Findings demonstrate the need to raise awareness about long COVID and for clinical care of patients in sub-Saharan Africa

LAGOS --- For the first time, scientists have found individuals in Nigeria are experiencing neurological manifestations of long COVID — called neuro-long COVID — such as brain fog, mild cognitive impairment, fatigue, sleep problems, headache, sensations of pins and needles, and muscle pain.

The study was a collaboration between scientists at Northwestern Medicine and a Nigerian team of scientists from the University of Lagos and Lagos University Teaching Hospital (LUTH) in Lagos, Nigeria. Of the 2,319 participants, 106 (4.6%) had long COVID with neurologic symptoms, and some were still experiencing symptoms up to two years after their initial episode of COVID-19. Researchers also found patients who were hospitalized for COVID-19 pneumonia reported a higher frequency of long COVID symptoms than those who were not hospitalized and had mild initial COVID-19 (11.5% vs 3.9%, respectively). 

The findings were published today, October 24, in the Journal of NeuroVirology.

The findings highlight the need for improved screening, diagnosis and treatment of neuro-long COVID in Nigeria.  

“Based on this data, there is hopefully going to be some intervention to alleviate their suffering,” said Dr. Igor Koralnik, chief of neuro-infectious disease and global neurology at Northwestern University Feinberg School of Medicine. “We’ve determined that even in a resource-limited setting where people have many other problems to worry about, we can still perform these studies, find those patients, and diagnose them.”

Scientists from the Nigerian team include neurologist Dr. Njideka U. Okubadejo and infectious disease physician Dr. Iorhen E. Akase, both of the University of Lagos and LUTH.

Koralnik and his team launched the Northwestern Medicine Neuro-COVID-19 Clinic in May 2020 and were soon evaluating a large number of patients who were exhibiting post-COVID neurologic symptoms. They then began researching the disease. In Nigeria, the opposite has happened. People in Nigeria are not aware that long COVID is a disease for which symptomatic treatments are available, and there was a scarcity of post-COVID clinics even during the height of the pandemic.

“This is why we have to start by doing the research to demonstrate the need for diagnosis and clinical care of these patients and advocate for specialized outpatient clinics,” Koralnik said. “If you don’t know that something exists, you can’t treat it.” 

Breakdown of neurologic symptoms

The predominant neurologic symptoms among study participants at any time during the disease course included:

• Difficulty remembering/brain fog (59.4%)
• Fatigue (55.7%)
• Sleep problems (32%)
• Headache (31%)
• Paresthesia, or numbness and pins and needles (11.3%)
• Myalgia, or muscle pain (9.4%).

Of the 66 participants with neuro-long COVID who underwent an in-person neurological evaluation and cognitive screening, 16.9% completed the Montreal Cognitive Assessment, a widely used screening assessment for detecting cognitive impairment, and had results consistent with mild cognitive impairment.

Next steps

In a future study, the scientists plan to treat brain fog and cognitive dysfunction in neuro-long COVID patients in Nigeria by applying the same techniques he and his team are currently using in Chicago, Koralnik said.

COVID-19 continues to occur despite vaccination and boosters, and according to an ongoing household pulse study carried out by the National Center for Health Statistics, approximately 14 million adults in the U.S. are currently experiencing long COVID. Long COVID principally affects adults in their prime, affecting their quality of life and ability to work, contributing to profound public health and socio-economic impacts.

Millenia Jimenez who works in the Koralnik laboratory at Northwestern is a co-author on the study.

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